Background & Aims
Chronic shoulder pain is associated with high disability that impacts an individual’s daily life activities and their overall quality of life. Therefore, the assessment of health-related quality of life (HRQoL) is relevant in this population, especially in economic evaluations investigating cost-effective interventions. HRQoL questionnaires identify health states based on a society’s preferences. These health states are identified to obtain the utility values used in economic evaluations for the calculation of the quality-adjusted life years (QALYs). QALYs is a generic measure that allows comparisons across different interventions and health conditions. The most instruments used to measure HRQoL in economic evaluations are the EQ-5D-3L and EQ-5D-5L. However, the measurement properties of these instruments have not been tested for Brazilian patients with chronic shoulder pain yet. Thus, the aim of this study is to fill this gap in terms of reliability and construct validity.
Methods
Adults (over 18 years old) of both sexes with shoulder pain for more than 3 months were included in this study. Data collection was conducted at two time points (baseline and 7-day interval). The self-reported version of the EQ-5D-3L, EQ-5D-5L, EQ-VAS, Shoulder Pain and Disability Index (SPADI), and Global Perceived Effect Scale (GPE) were administered. Reliability was assessed by the intraclass correlation coefficient (ICC) and a 95% confidence interval [CI] for the EQ-EVA, and by the Kappa coefficient for the descriptive systems of the EQ-5D-3L and EQ-5D-5L (values ?0.70 was considered adequate). Measurement error was assessed by the standard error of measurement and minimal detectable change for the EQ-VAS, and by the percentage of agreement for the descriptive systems. Construct validity was assessed by hypotheses test using the Spearman correlation between the EQ-5D-3L, EQ-5D-5L, SPADI, and GPE (r<0.30 representing weak, r?0.30 or r<0.60 moderate, and r?0.60 strong correlation).
Results
This is a partial result considering data from 34 participants. The patients presented mean age of 54 years with pain duration of 24 months. Reliability was excellent for the EQ-EVA (ICC=0.93), and adequate for the EQ-5D-3L and EQ-5D-5L (kappa?0.70).The measurement errors of the EQ-VAS, EQ-5D-3L, and EQ-5D-5L were considered very good. Construct validity showed a strong correlation between the descriptive systems of the EQ-5D instruments for similar dimensions (r?0.6), and a weak to strong correlations between different dimensions (r=0.04 to 0.6). There were weak to moderate correlations (r=0.1 to 0.4) for the EQ-EVA and descriptive systems of the EQ-5D-3L and EQ-5D-5L . There were moderate to strong correlations (r=0.43 to 0.64) for the EQ-VAS and SPADI. There were weak to moderate correlations (r=0.1 to 0.5) for the SPADI and the descriptive systems of the EQ-5D-3L and EQ-5D-5L. There were weak to moderate correlations (r=0.1 to 0.5) for the GPE and EQ-VAS, EQ-5D-3L, and EQ-5D-5L.
Conclusions
The results of this study suggest that the EQ-VAS, EQ-5D-3L, and EQ-5D-5L can be used for the assessment of the HRQoL as these instruments present adequate reliability, measurement errors, and construct validity for patients with chronic shoulder pain. However, the construct validity related to the comparison between the SPADI and descriptive systems of EQ-5D-3L, and EQ-5D-5L presented weak to moderate correlations, with the highest correlation observed between the disability dimension of SPADI and the self-care dimension of EQ-5D-5L. This can be explained by the fact that the disability dimension of the SPADI focus on the activities that the patient shows difficulties to realize in their daily routine, resembling what is asked at the self-care dimension in the EQ-5D instruments.
References
Whitehead SJ, Ali S. Health outcomes in economic evaluation: The QALY and utilities. Br Med Bull. 2010;96(1):5-21. doi:10.1093/bmb/ldq033
Miyamoto GC, Ben ÂJ, Bosmans JE, et al. Interpretation of trial-based economic evaluations of musculoskeletal physical therapy interventions. Brazilian J Phys Ther. 2021;000(xxxx). doi:10.1016/j.bjpt.2021.06.011
Buchholz I, Janssen MF, Kohlmann T, Feng YS. A Systematic Review of Studies Comparing the Measurement Properties of the Three-Level and Five-Level Versions of the EQ-5D. Pharmacoeconomics. 2018;36(6):645-661. doi:10.1007/s40273-018-0642-5
Garratt AM, Furunes H, Hellum C, et al. Evaluation of the EQ-5D-3L and 5L versions in low back pain patients. Health Qual Life Outcomes. 2021;19(1):1-9. doi:10.1186/s12955-021-01792-y
Presenting Author
Vinicius Sacioti Vaz
Poster Authors
Vinícius Sacioti
Master's student
University of São Paulo
Lead Author
Gisela Cristiane Miyamoto
Universidade Cidade de São Paulo
Lead Author
Gisele Harumi Hotta; Phd
Universidade Cidade São Paulo (UNICID), São Paulo – SP
Lead Author
Maria Eduarda Francelino; Graduation student
School of Medicine of Ribeirão preto, University of São Paulo
Lead Author
Anamaria Siriani de Oliveira
Universidade de São Paulo
Lead Author
Topics
- Economics, Ethics, and Law